Cough headaches

Overview

Cough headaches are a type of head pain triggered by coughing and other types of straining. This may include sneezing, blowing your nose, laughing, crying, singing, bending over or having a bowel movement.

Cough headaches are fairly uncommon. There are two types: primary cough headaches and secondary cough headaches. Primary cough headaches are usually harmless, are caused only by coughing and get better quickly without treatment. A primary cough headache is diagnosed only when a provider has ruled out possible causes other than coughing.

A secondary cough headache may be triggered by a cough, but it is caused by problems with the brain or structures near the brain and spine. Secondary cough headaches can be more serious and may require treatment with surgery.

Anyone who has a cough headache for the first time should see their health care provider. The provider can determine whether a cough or something else caused the pain.

Symptoms

Symptoms of cough headaches:

• Begin suddenly with and just after coughing or other types of straining
• Typically last a few seconds to a few minutes — some can last up to two hours
• Cause sharp, stabbing, splitting or "bursting" pain
• Usually affect both sides of your head and may be worse in the back of your head
• May be followed by a dull, aching pain for hours

Secondary cough headaches often present with only a cough headache, but you may also experience:

• Longer lasting headaches
• Dizziness
• Unsteadiness
• Fainting
• Ringing in the ears or hearing loss
• Blurred vision or double vision
• Tremor

A cough headache only happens right after coughing. Other headache pain is not a cough headache if you already had a headache when you coughed, or if you have a headache condition such as migraine. For example, people with migraine might find that their headaches get worse when they cough. This is normal, and not a cough headache.

When to see a doctor

Consult your doctor or health care provider if you experience sudden headaches after coughing — especially if the headaches are new, frequent or severe or you have any other troubling signs or symptoms, such as imbalance or blurred or double vision.

Causes

Primary cough headaches

The cause of primary cough headaches is unknown.

Symptoms

Secondary cough headaches

Secondary cough headaches may be caused by:

• A defect in the shape of the skull.
• A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations.
• A weakness in one of the blood vessels in the brain (cerebral aneurysm).
• A brain tumor.
• A spontaneous cerebrospinal fluid leak.

Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the CSF leak. This is one of the reasons why it's important to see your provider for a new cough headache.

Risk factors

Risk factors for cough headaches vary widely based on the type and cause of the headache.

Prevention

After talking with your provider, here are some tips to prevent actions that trigger your cough headaches — whether that's coughing, sneezing or straining while using the toilet. This may help reduce the number of headaches you experience. Some preventive measures may include:

• Treating conditions that would cause coughing, such as bronchitis or other lung infections
• Avoiding medications that cause coughing as a side effect
• Getting an annual flu shot
• Using stool softeners to avoid constipation
• Minimizing heavy lifting or bending for long periods

While these steps may help prevent a cough headache, any headache related to coughing or straining should always be checked by your provider.

Diagnosis

Your doctor may recommend brain-imaging tests, such as MRI or CT scans, to rule out other possible causes for your headaches.

• Magnetic resonance imaging (MRI). During an MRI, a magnetic field and radio waves are used to create cross-sectional images of the structures within your head to determine any problems that may be causing your cough headache.
• Computerized tomography (CT) scan. These scans use a computer to create cross-sectional images of your brain and head by combining images from an X-ray unit that rotates around your body.
• Lumbar puncture (spinal tap). Rarely, a spinal tap (lumbar puncture) may be recommended. During a spinal tap, the provider removes some of the fluid that surrounds your brain and spinal cord.

Treatment

Treatment differs, depending on whether you have primary or secondary cough headaches.

Primary cough headache

If you have a history of primary cough headaches, your doctor may recommend that you take daily medication to help prevent or reduce the pain.

These preventive medications may include:

• Indomethacin (Indocin), an anti-inflammatory drug
• Propranolol (Inderal LA), a medication that relaxes blood vessels and reduces blood pressure
• Acetazolamide, a diuretic that reduces the amount of spinal fluid, which can reduce the pressure inside the skull

Other medications used to treat primary cough headache include methysergide, naproxen sodium (Aleve), methylergonovine, intravenous dihydroergotamine (D.H.E. 45) and phenelzine (Nardil).

Secondary cough headache

If you have secondary cough headaches, surgery is often needed to fix the underlying problem. Preventive medications usually don't help people who have secondary cough headaches. However, responding to medication doesn't necessarily mean that you have a primary cough headache.

Preparing for an appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including past illnesses and operations, major stresses or recent life changes, recent accidents, details about what happened when the cough headache started, and any medical problems that run in your family.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your provider.

Your time with your provider is limited, so preparing a list of questions will help you make the most of your time together. For cough headaches, some basic questions to ask include:

• What's the most likely cause of my headaches?
• Are there any other possible causes?
• What kinds of tests do I need?
• When will these headaches go away?
• What treatments are available?
• Are there any alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage these conditions together?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your doctor or provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your provider may ask:

• When did you first begin experiencing cough headaches?
• Have your cough headaches been continuous or occasional?
• Have you had a similar problem in the past?
• Have you had other kinds of headache? If so, what were they like?
• Has anyone in your immediate family experienced migraines or cough headaches?
• What, if anything, seems to improve your headaches?
• What, if anything, makes your headaches worse?